A client who experienced a myocardial infarction 4 days ago refuses to dangle at the bedside, saying, "If my doctor tells me to do it, I will. Otherwise, I won't." The nurse determines that the client is likely displaying?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

The client's refusal to act without a direct command from the doctor demonstrates a reliance on an authority figure for permission and safety.
This behavior, where a person relinquishes their own autonomy and decision-making, is characteristic of dependency.
Dependency is a common coping mechanism following a frightening, life-threatening event like an MI, as the patient may feel a profound loss of control over their own body and life.

Why Other Options Were Wrong

Option A: The client's statement is not hostile, blaming, or irritable, which are the hallmarks of anger.
Option B: The client is not minimizing the reality of the heart attack; rather, they are seeking explicit direction for their care, which acknowledges the seriousness of the situation.
Option C: The client's refusal is conditional, not absolute. They are willing to act under a specific circumstance, which is different from the hopelessness, withdrawal, and lack of motivation seen in depression.

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to Psychological responses to acute illness to guide bedside assessment, documentation, and the next nursing action.
Recognizing dependency is crucial for nurses to empower patients, promote self-care, and prevent a state of learned helplessness, which can hinder long-term recovery and rehabilitation.
Nurses should aim to foster a therapeutic relationship that encourages patient participation and gradually increases their sense of control and independence.
What if the client's family was answering for them, saying 'They will only do it if the doctor says so'? This would still point to dependency, but it would also indicate a family dynamic that enables this behavior, requiring the nurse to include the family in the plan to promote the client's autonomy.

How to Approach the Question

First, analyze the question type. This is a clinical scenario question that requires you to interpret a client's statement.
Carefully read the client's exact words: "If my doctor tells me to do it, I will. Otherwise, I won't."
Identify the core behavior or emotion in the quote. The statement is conditional and defers authority to the doctor.
Evaluate each option against this core behavior. The statement is not angry, it doesn't deny the illness, and it's not a sign of hopeless depression.
Conclude that the statement perfectly matches the definition of dependency: relying on an external authority for permission and direction.
Select the option that aligns with this analysis.

Concept Tested & Keywords

Concept Tested: Psychological responses to acute illness
Stem keywords: myocardial infarction, refuses to dangle, doctor tells me to do it
Lead-in keywords: likely displaying
Clinical cues: Client's direct quote reveals their thought process.
Clinical cues: The event was recent (4 days ago), indicating an acute psychological response.

Question ID

QnV6PZyBJygH7y8WupvMi9

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2667-2669

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 7301-7303

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